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8 Apr 2024

Tags: Endocrinology | Medical Emergencies


Obesity, recognized as a metabolic disease characterized by the excessive accumulation of body fat, presents a significant threat to public health worldwide. Defined by a prolonged energy imbalance where intake surpasses expenditure, obesity not only endangers individual well-being but also strains healthcare systems and economies.

According to the World Health Organization (WHO), the prevalence of obesity has reached epidemic proportions, claiming the lives of four million people annually and burdening societies with substantial healthcare costs.

Aetiology & Risk Factors

The etiology of obesity, or the causes behind its development, is complex and multifactorial, involving a combination of genetic, environmental, behavioral, and socioeconomic factors. Here’s a breakdown of some key aspects contributing to the development of obesity:


While genetic predisposition doesn’t solely determine obesity, it can significantly influence an individual’s susceptibility. Certain genes can affect metabolism, fat distribution, and how the body processes nutrients, making some people more prone to gaining weight than others.


The environment in which a person lives, works, and plays heavily influences their risk of obesity. Factors such as easy access to high-calorie, processed foods, sedentary lifestyles due to desk jobs or lack of recreational spaces for physical activity, and urban designs that discourage walking or cycling all contribute to the rising rates of obesity.

Dietary Choices

Poor dietary choices, including excessive consumption of energy-dense foods high in fats, sugars, and refined carbohydrates, along with low intake of fruits, vegetables, and whole grains, are major contributors to obesity. Additionally, frequent consumption of large portion sizes and reliance on fast food and sugary beverages contribute significantly to weight gain.

Physical Activity Levels

Sedentary lifestyles devoid of regular physical activity increase the risk of obesity. Engaging in less than the recommended amount of moderate-to-vigorous physical activity exacerbates weight gain and contributes to metabolic imbalances.

Socioeconomic Status

Lower socioeconomic status is strongly associated with higher rates of obesity. Individuals with limited financial resources may have restricted access to healthy foods due to cost constraints and may reside in neighborhoods with limited recreational facilities and safe outdoor spaces for physical activity.

Psychological Factors

Psychological issues such as stress, depression, anxiety, and trauma can lead to emotional eating and contribute to weight gain. Coping mechanisms such as overeating or seeking comfort in high-calorie foods can perpetuate unhealthy eating behaviors and exacerbate obesity.

Medical Conditions

Certain medical conditions, such as hypothyroidism, Cushing’s syndrome, and polycystic ovary syndrome (PCOS), can contribute to weight gain. Moreover, medications like corticosteroids, antidepressants, antipsychotics, and some contraceptives may have side effects that include weight gain, further increasing obesity risk.

Family History

Individuals with a family history of obesity are more likely to develop obesity themselves. This can be attributed to a combination of genetic predisposition and shared environmental and behavioral factors within families.

Clinical History & Examinations

When it comes to assessing and managing obesity, a comprehensive clinical history and examination are essential components of the evaluation process. Obesity primarily manifests as an accumulation of excess body fat and weight that surpasses the average for an individual’s height.

Clinical History

Weight History: Inquire about the patient’s weight history, including any fluctuations, patterns of weight gain or loss, and efforts made to manage weight in the past.

Dietary History: Gather information about the patient’s typical dietary intake, including meal patterns, portion sizes, frequency of fast food or high-calorie food consumption, snacking habits, and any recent changes in eating habits.

Physical Activity: Assess the patient’s level of physical activity, including types of activities engaged in, duration, frequency, and any barriers to exercise.

Medical History: Review the patient’s past medical history, focusing on conditions associated with obesity such as hypertension, diabetes, dyslipidemia, sleep apnea, osteoarthritis, and cardiovascular disease. Also, inquire about any relevant surgical history or medications that may affect weight.

Family History: Explore the patient’s family history of obesity or related conditions, as genetics can influence susceptibility to obesity.

Psychosocial Factors: Evaluate psychosocial factors that may contribute to weight gain or hinder weight management efforts, such as stress, depression, anxiety, body image concerns, emotional eating, and history of trauma or abuse.

Obesity-related Complications: Inquire about any symptoms or complications related to obesity, such as joint pain, shortness of breath, fatigue, or symptoms of metabolic syndrome.

Lifestyle Factors: Assess other lifestyle factors that may impact weight, including sleep patterns, smoking status, alcohol consumption, and substance use.


Body Measurements: Measure height, weight, and calculate body mass index (BMI). Assess waist circumference as an indicator of central adiposity.

Body Mass Index

Vital Signs: Record blood pressure, heart rate, and respiratory rate.

Signs of Obesity-related Conditions: Look for physical signs suggestive of obesity-related conditions such as acanthosis nigricans (associated with insulin resistance), striae (stretch marks), or signs of venous stasis.

Acanthosis Nigricans


Obesity can lead to a wide range of complications affecting various systems of the body. Some of the most common complications associated with obesity include:

Cardiovascular Diseases

Obesity is a major risk factor for heart disease, including coronary artery disease, heart attack, and stroke. It can lead to hypertension (high blood pressure), dyslipidemia (abnormal levels of cholesterol and triglycerides), and atherosclerosis (hardening and narrowing of the arteries).

Type 2 Diabetes

Obesity is strongly associated with insulin resistance and type 2 diabetes. Excess body fat, especially around the abdomen, can interfere with insulin function, leading to elevated blood sugar levels.

Respiratory Problems

Obesity can cause respiratory complications such as sleep apnea, which involves repeated interruptions in breathing during sleep. It can also lead to obesity hypoventilation syndrome (OHS), a condition characterized by decreased breathing during sleep and awake periods.

Joint Problems

The excess weight carried by obese individuals puts added stress on the joints, particularly those in the knees, hips, and lower back. This can lead to osteoarthritis, a degenerative joint disease characterized by pain, stiffness, and reduced mobility.

Gastrointestinal Disorders

Obesity increases the risk of developing gastroesophageal reflux disease (GERD), a condition in which stomach acid flows back into the esophagus, causing heartburn and potentially leading to complications like esophagitis and Barrett’s esophagus. Obesity is also linked to gallbladder disease and non-alcoholic fatty liver disease (NAFLD).


Obesity has been associated with an increased risk of certain types of cancer, including breast cancer, colorectal cancer, endometrial cancer, and prostate cancer.

Psychological Disorders

Obesity can have a significant impact on mental health, leading to depression, anxiety, low self-esteem, and body image issues. Social stigma and discrimination related to weight can exacerbate these psychological effects.

Reproductive Complications

Obesity can affect fertility in both men and women. In women, it can lead to irregular menstrual cycles, polycystic ovary syndrome (PCOS), and complications during pregnancy, such as gestational diabetes, preeclampsia, and increased risk of cesarean delivery. In men, obesity can cause hormonal imbalances and reduce sperm quality.

Skin Problems

Obesity increases the risk of skin conditions such as intertrigo (skin irritation or inflammation in skin folds), cellulitis (bacterial skin infection), and acanthosis nigricans (dark, velvety patches of skin).

Overall, obesity is a complex and multifaceted condition that can have a profound impact on physical health, mental well-being, and quality of life. It is important for individuals who are overweight or obese to work with healthcare professionals to develop a comprehensive plan for weight management and reduce the risk of associated complications.

Obesity Complications

Key Points

  • Obesity is characterized by an excessive accumulation of body fat, leading to a weight that exceeds the average for an individual’s height.

  • It is commonly diagnosed using body mass index (BMI), calculated by dividing weight in kilograms by height in meters squared, with a BMI of 30 or higher indicating obesity.

  • Obesity is associated with numerous health risks, including cardiovascular disease, type 2 diabetes, certain cancers, and musculoskeletal problems, highlighting the importance of prevention and management strategies.


Centers for Disease Control and Prevention. (2022, June 3). About Adult BMI . Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html

National Health Service. (2023, February 15). Obesity. NHS; NHS. https://www.nhs.uk/conditions/obesity

Nolamedia. (n.d.). Our Children, Our Future and the Disease That Threatens Both. Ghgb. https://ghgb.pbrc.edu/curing-the-obesity-epidemic